Lecture 13: Respiratory pharmacology Flashcards by Emily Densham

What are the three categories of bronchodilator?

Adrenergic agonists - beta2 agonists (Salbutamol, Salmeterol, formoterol)

Anticholinergics (Tiotropium, ipratropium)

Methylxanthines (Aminophylline)

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What are the two categories of anti-inflammatory drug?

Steroids  (Prednisolone, Beclomethasone)
Leukotriene Inhibitors (Monteleukast)

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What is the duration of action of salbutamol?

Short acting (begin immediately, 3-5 hour duration)

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What is/are the routes of administration of salbutamol?

Inhaled or nebuliser (higher dose)

IV – very rarely used

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What is the mechanism of action of salbutamol?

Binding to beta2 receptors in the lungs

Results in relaxation of bronchial smooth muscles

Increases cAMP production by activating adenylate cyclase and cAMP

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What kind of drug is salbutamol?

SABA

Bronchodilator

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What is salbutamol used for?

Asthma and COPD

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Which drugs can be used in a medical emergency?

Salbutamol
Tiotropium
Ipratropium
Theophylline
Oxygen

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What is the duration of salmeterol?

Long acting (begin 2-30 min, 10-12 hour dur)

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What is the route of salmeterol administration?

Inhaled

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What kind of drug is salmeterol?

LABA

Bronchodilator

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What is salmeterol used for?

Asthma: in patients requiring long-term regular bronchodilator therapy on ICS
(always used with ICS in asthma)

COPD: persistent symptoms despite therapy
(either stand alone or as ICS/LABA combination FEV1 < 50%)

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What is the duration of formoterol?

Long acting (with short onset similar to salbutamol but with prolonged duration 10-12 hours)

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What is the route of formoterol administration?

Inhaled

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What type of drug is formoterol?

LABA

Bronchodilator

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What is formoterol used for?

Asthma
(always combined with ICS)

MART

COPD

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What is the duration of tiotropium?

Long acting (24 hour) – one a day

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What is the route of tiotropium administration?

Inhaled (Dry powder Handihaler/Mist resimat)

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What is tiotropiums mechanism of action?

Similar affinity to the subtypes of muscarinic receptors, M1 to M5

In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilatation

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What type of drug is tiotropium?

LAMA

Anticholinergic

Bronchodilator

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When is tiotropium used?

Stable COPD: Symptoms despite SABA (any severity and with LABA)

Asthma: in not improving despite ICS/LABA specialist treatment from hospital

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What type of drug is ipratropium?

SAMA

Anticholinergic

Bronchodilator

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What is the duration of ipratropium?

Onset 30 minutes; lasts 6 hours

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What is the method of administration of ipratropium?

MDI

Nebulised

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When is ipratropium used?

Nebulised for acute presentations of COPD and sometimes asthma

What is the duration of theophylline action?

Half life around 5 hours healthy adults

What is the route of theophylline administration?

Oral IV

What is the mechanism of theophylline action?

Phosphodiesterase inhibitor Requires monitoring of level (blood test)

When is theophylline used?

PO: COPD and asthma –persistent symptoms IV: COPD and asthma medical emergencies

What are the adverse events of the bronchodilators?

Tachycardia Nervousness Irritability Tremor Inhaled preparations: less common ``` Oral preparations (hardly used): More common Tachyarrhythmias Angina ``` Usually dose related

Which glucocorticoid is systemic?

Prednisolone

What are the features of systemic glucocorticoids?

IV or oral Stronger effects Action unaffected by lung restriction More side effects, esp with long term therapy

Which glucocorticoid is inhaled?

Beclometasone

What are the key features of inhaled glucocorticoids?

Localized action Fewer side effects: some absorption occurs Disease may prevent penetration of drug to affected areas

What are the airway effects of glucocorticoids?

Decrease release of inflammatory mediator Decrease infiltration and action of WBCs Decrease airway oedema Decrease airway mucus production Increase number and sensitivity of beta-2 receptors

What are the possible side effects of glucocorticoids?

Oral candidiasis Dysphonia Adrenal suppression Bone loss Slow growth in children, but not ultimate height Increase risk of cataracts and glaucoma Increased risk of infection Gastric ulceration Hypertension Diabetes Mood disturbance

What are antihistamines?

Allergic rhinitis medications Cetirizine, Chlorpheniramine H1 antagonists Side effects: Drowsiness, Dry Mouth, Dry Eyes, Confusion

What are intranasal glucocorticoids used for?

Allergic rhinitis medication

What is monteleukast?

Allergic rhinitis medication Inhibit leukotriene receptors ↓inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils

What are sympathomimetics?

Allergic rhinitis medication Decongestants

What is amoxicillin?

Penicillin Moderate-spectrum, bacteriolytic, B lactam antibiotic

What is amoxicillins routes of administration?

IV Oral

When is amoxicillin used?

CAP COPD exacerbations Bronchitis

What type of bacteria is killed by amoxicillin?

Gram negative and gram positive

What is co-amoxiclav?

Penicillin Amoxicillin is susceptible to degradation by B lactamase -producing bacteria so can be combined with clavulinic acid – a beta lactamase inhibitor

What are tetracyclines?

Antibiotics Tetracycline inhibits protein synthesis Broad spectrum action Gram positive and negative Useful for ‘atypical infections’ e.g. mycoplasma, legionella

Name a tetracycline.

Doxycycline

What is the route of tetracycline administration?

Oral

What are the side effects of tetracyclines?

``` GI Upset Staining teeth Lupus Allergy Photosensitivity ```

What are quiolones?

Antibiotic Mechanism of action - DNA fragmentation

Name a quinolone.

Ciprofloxacin | Moxifloxacin

What is the route of administration of quinolones?

IV Oral Inhaled (CF)

What are the side effects of quinolones?

``` GI upset C difficile Tendonitis Liver upset Prolonged QTc and arrthymia ```

What are macrolides?

Antibiotics Mechanism of action - Protein synthesis inhibitors

Name a macrolide.

Erythromycin | Clarithromycin

What is the route of macrolide administration?

IV Oral

What bacteria are killed by quinolones?

Gram negative and positive coverage (And Pseudomonas)

What bacteria are killed by macrolides?

Gram positive /limited gram negative cover

What are the side effects of macrolides?

GI Allergy Liver abnormality Prolonged QTc and interactions

What can be used to treat some idiopathic interstitial pneumonias (hypersensitivity pneumonia)?

Prednisolone Azathioprine MMF

What can be used to treat sarcoid?

Prednisolone

What can be used to treat idiopathic pulmonary fibrosis?

Pirfenidone Anti inflammatory/ Anti Fibrotic Reduces fibroblast proliferation Reduces collagen production

Lecture 13: Respiratory pharmacology Flashcards

(62 cards)